Short-term cardiac adaptation to severe haemodilution: an echocardiographic study in normal and hypertensive subjects

• Published in: European heart journal Vol. 15; no. 5; p. 637
• Main Authors: Bombardini, T, Borghi, B, Zacà, F, Picano, E, Caroli, G C
• Format: Journal Article
• Language: English
• Published: England 01.05.1994
• Subjects: Christianity; Echocardiography; Female; Hemodilution; Hemodynamics - physiology; Hip Prosthesis; Humans; Hypertension - diagnostic imaging; Hypertension - physiopathology; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - physiopathology; Intraoperative Complications - epidemiology; Male; Middle Aged; Postoperative Complications - epidemiology; Risk Factors; Vascular Resistance - physiology
• ISSN: 0195-668X
• DOI: 10.1093/oxfordjournals.eurheartj.a060560

In order to avoid transfusion risks and optimize blood bank resources, in recent years many blood sparing techniques have been proposed, including severe haemodilution. The aim of this study is to assess the pattern of normal haemodynamic and cardiac adaptation to severe haemodilution in patients undergoing major orthopaedic surgery and refusing blood transfusions for religious reasons (the patients were Jehovah's Witnesses). Two-dimensionally guided M-mode echocardiograms were performed at baseline and 4 days after major orthopaedic surgery in 26 Jehovah's Witnesses (age 61 +/- 11 years), with normal regional and global baseline left ventricular function and no valvular disease. Left ventricular (LV) volumes were estimated by using the Teichholz formula. From the latter, we calculated ejection fraction and stroke volume, cardiac output (stroke volume x heart rate), and total peripheral resistance estimated as mean arterial pressure by cuff sphygmomanometer x 80/cardiac output. On the basis of LV mass (ASE-cube corrected by Devereux), two groups were identified: non-hypertrophic (LV mass index < 110 g.m-2 in women and < 130 g.m-2 in males) and hypertrophic. In the 19 patients without LV hypertrophy, haemoglobin decreased from 13.5 +/- 1.6 (mean +/- standard deviation) g.dl-1 (at baseline) to 8.7 +/- 1.3 post-operation (P < 0.01), and peripheral vascular resistances fell from 2131 +/- 450 to 1278 +/- 310 (dyne.s.cm-5) (P < 0.01).